Basic Information
Provider Information
NPI: 1841549730
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CHRISTENSEN
FirstName: KYRA
MiddleName: C
NamePrefix:  
NameSuffix:  
Credential: CRNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 5323 HARRY HINES BLVD
Address2:  
City: DALLAS
State: TX
PostalCode: 753909087
CountryCode: US
TelephoneNumber: 4126473087
FaxNumber:  
Practice Location
Address1: 6201 HARRY HINES BLVD
Address2:  
City: DALLAS
State: TX
PostalCode: 753900001
CountryCode: US
TelephoneNumber: 2146335555
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/06/2012
LastUpdateDate: 02/18/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 02/18/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363L00000XRN568534PAN Physician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner 
363LA2100XAP144583TXY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care

No ID Information.


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